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目的 :探讨进展期胃上部癌行根治性全胃切除的可行性及间置环形空肠代胃消化道重建术的临床应用价值。方法 :对15 7例进展期胃上部癌行根治性全胃切除术 ,消化道重建则采用间置环形空肠代胃术式 ;并与同期 2 86例胃上部癌行近侧胃大部切除比较Ⅱ～Ⅲ期患者术后 3年、5年生存率。结果 :术后早期无死亡 ,膈下及腹腔感染 4例 ,无反流性食管炎 ,无倾倒综合征。Ⅰ期全胃组及近侧胃切除组术后生存率差异均无显著性 (P >0 .0 5 ) ;Ⅱ期患者两组 1年和 3年生存率差异无显著性 (P>0 .0 5 ) ,而 5年生存率差异有显著性 (P <0 .0 5 ) ;Ⅲ期两组间 1年、3年和 5年生存率差异均有显著性 (P <0 .0 5～P <0 .0 0 5 )。结论 :根治性全胃切除术应是Ⅲ期胃上部癌的常规术式 ;而间置环形空肠代胃术式符合生理要求 ,并发症少。
Objective: To explore the feasibility of radical total gastrectomy for advanced gastric cancer and the clinical application value of interstitial gastrojejunal gastroenteric reconstruction. METHODS: Radical total gastrectomy was performed on 157 cases of advanced gastric cancer, and gastrointestinal jejunal reconstructive surgery was performed using an interposed jejunal jejunum. The results were compared with proximal gastrectomy in 286 upper stomach cancers during the same period. The 3-year and 5-year survival rates of patients with stage II-III disease. RESULTS: There were no deaths in the early postoperative period, 4 cases in the armpit and abdominal cavity, no reflux esophagitis, and no dumping syndrome. There was no significant difference in postoperative survival rate between stage I gastric resection group and proximal gastrectomy group (P > 0.05). There was no significant difference in the 1-year and 3-year survival rates between the two groups (P > 0). There was a significant difference in 5-year survival rate (P < 0.05) between the two groups. There was a significant difference in 1-year, 3-year and 5-year survival rates between the two groups (P <0.05). P <0. 0 0 5 ). Conclusion : Radical total gastrectomy should be the routine operation for stage III upper stomach cancer. The interposition of circular jejunum to replace the stomach conforms to physiological requirements and has few complications.